From Invisible to Visible - Positive Deviance Initiative

SHEA Abstract: Billings
Hospital-wide Decrease In Methicillin-resistant Staphylococcus aureus (MRSA) After an
Intervention In a Community Hospital
Author Block: Nancy J Iversen 1 , BSN, RN, CIC; Pei-Jean Chang 2 , MPH; Jennifer Mellgren-Blackford 1 , MT
(ASCP), CIC; Christine Nightingale 1 BSN, RN, CIC; David Graham, MD; Camilla Saberhagen, MD; Edward
Septimus, MD; John Stelling, MD 2 ; Katherine Ellingson, PhD 3 ; John Jernigan, MD, MS 3 .
1 Billings Clinic, Billings, MT, USA; 2 Centers for Disease Control and Prevention, Atlanta, GA, USA; 3 Harvard
University, Boston, MA, USA
Background:
In January 2007, the Billings Clinic (a 270 bed community hospital in Billings, MT) initiated an
MRSA prevention program consisting of active surveillance culturing of patients admitted to the
intensive care unit (ICU), Contact Precautions for any patient in the hospital known to be colonized
or infected with MRSA, hand hygiene, and hospital-wide implementation of the Positive
Deviance approach to behavioral and cultural change to improve adherence to infection control
practices.
Objective:
To assess the impact of the intervention on hospital-wide incident cases of MRSA using interrupted
time-series (ITS) analyses.
Methods:
The intervention was introduced in January 2007. Active surveillance testing for MRSA was conducted
only in a 22 bed medical-surgical ICU accounting for all ICU beds in the hospital and 10%
of total hospital patient-days. Hospital-wide incidences of clinical MRSA isolates were calculated
from 1/1/2004 to 8/31/2008. Incident MRSA cases were identified by positive, non-surveillance cultures
obtained more than 48 hours after admission from patients with no positive cultures in the
previous year. Monthly hospital-wide MRSA incidence densities were modeled using Poisson ITS
regression analyses. Autocorrelation was assessed using a Durban-Watson statistic.
Results:
On average MRSA incidence decreased from 1.2 per 1000 patient-days in the pre-intervention period
to 0.27 per 1000 patient days in the last six months of the post-intervention period (p=0.0001).
In the 20 months since intervention, hospital-wide incidence significantly decreased by 8.4% per
month (95%CI=4.4-12.1%, p